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Objective: To examine the association between maternal depression and anxiety disorders (MDAD) and child development assessed during the kindergarten year. Methods: Administrative data from several health and social databases in Manitoba, Canada, were used to study 18,331 mother-child pairs. MDAD over the period from one year prior to the child's birth to the kindergarten year was defined using physician diagnoses and filled prescriptions. Child development was assessed during the kindergarten year using the Early Development Instrument (EDI) which measures vulnerability across five domains of development. Structural equation modeling was used to examine associations between timing, recurrence and severity of MDAD and child outcomes. Health at Birth (preterm, low birth weight, neonatal intensive care stay and long birth hospitalization), Family Context (teen mother, lone parent, socio-economic status (SES)), child age and child sex were covariates. Results: MDAD had a modest negative association with child EDI scores across all models tested, particularly for social, emotional and physical development. Prenatal MDAD had a stronger negative association with outcomes than other time periods; however, recurrent MDAD had a stronger negative association with outcomes than any specific time period or MDAD severity. The influence of MDAD was mediated by Family Context, which had a strong, negative association with outcomes, particularly language and cognitive development. Conclusion: The number of time periods a child was exposed to MDAD in early childhood was more negatively associated with five areas of child development than timing or severity. Prenatal exposure may be more sensitive to MDAD than other time periods. The familial context (teen mother, lone parenthood and low SES) had a stronger influence on child outcomes than MDAD. Findings can be used to inform interventions which address maternal mental health from the prenatal period onward, and to support disadvantaged families to encourage healthy birth outcomes, early childhood development and school readiness. [ABSTRACT FROM AUTHOR]

Information-rich environments, with access and funding provided by government, make it possible to organize longitudinal administrative data to support analyses of policy-relevant questions. This paper describes insights into children's well-being and social equity obtained from data available in Manitoba, Canada, and highlights findings that have engaged policymakers. Analyses draw on Manitoba-linked data providing information over time (going back to 1970 in some files) and across space (with residential location documented every six months) for each provincial resident. Routinely collected data from the Ministries of Health, Education, and Family Services and Consumer Affairs have been integrated with a population registry. Identifying risk factors and presenting outcomes by social groups and by local communities capture the attention of policymakers. Linking an individual's area of residence to census and health data has led to developing measures of population health status and socioeconomic status. These measures focus on whether delivery patterns track health and educational needs, and a population registry makes it possible to describe who is (and is not) served by each program. The nature of health and social research has been changed by the development of information-rich environments. Many findings in Manitoba could not be replicated without a population registry. Engaging decision makers through effective presentations can ensure continuing support for diverse efforts based on these environments, and this article suggests ways of better communicating with policymakers. [ABSTRACT FROM AUTHOR]

Objectives: To assess the ability of an Adjusted Clinical Group (ACG)-based morbidity measure to assess the overall health service needs of populations. Data Sources/Study Setting. Three population-based secondary data sources: registration and health service utilization data from fiscal year 1995-1996; mortality data from vital statistics reports from 1996-1999; and Canadian census data. The study included all continuously enrolled residents in the universal health care plan in Manitoba.Study Design: Using 60 small geographic areas as the units of analysis, we compared a population-based "ACG morbidity index," derived from individual ACG assignments in fiscal year 1995-1996, with the standardized mortality ratio (ages < 75 years) for 1996-1999. Key variables included a population-based socioeconomic status measure and age- and sex-standardized physician utilization ratios.Data Extraction Methods: The ACGs were assigned based on the complement of diagnoses assigned to persons on physician claims and hospital separation abstracts. The ACG index was created by weighting the ACGs using average health care expenditures.Principal Findings: The ACG morbidity index had a strong positive linear relationship with the subsequent rate of premature death in the small areas of Manitoba. The ACG index was able to explain the majority of the relationships between mortality and both socioeconomic status and physician utilization.Conclusions: In Manitoba, ACGs are closely related to premature mortality, commonly accepted as the best single indicator for health service need in populations. Issues in applying ACGs in settings where needs adjustment is a primary objective are discussed. [ABSTRACT FROM AUTHOR]

Proposes a framework for monitoring the impact of health reforms and other indicators that may be affected by health care reform. Occurrence of improvements in efficiency without harming the equitable delivery of health care services; Possibility that improvement within the health care system may be a prerequisite for addressing equity issues in health.

Examines the health care sector of Manitoba, a province north of Minnesota/North Dakota. Reform of the Canadian health care system; Examination of the outcome; Opposition to health care cuts in Minnesota; Effects of budget cutting; Problems which hospitals in Manitoba face; Importance of health care reform.

Background: As part of a recent project focused on needs-based planning for generalist physicians, the authors documented the variety of practice styles of primary care physicians for managing patients with hypertension. They investigated the validity of various explanations for these different styles and the relative contributions of physician and patient characteristics to the rates at which hypertensive patients contact physicians.Methods: Retrospective descriptive study using regression analyses to simultaneously adjust for the influence of key patient and physician characteristics. Hypertensive patients in Winnipeg were identified using Manitoba physician claims data for fiscal years 1993/94 and 1994/95. Patients were included if they were 25 years of age or more and had at least one physician contact in both 1993/94 and 1994/95 during which hypertension was diagnosed. In addition, the primary care physician had to be the physician that the patient contacted most frequently in 1993/94 and 1994/95 and with whom she or he had at least 2 visits during this period. Only patients of family practitioners whose practice included at least 50 hypertensive patients were included.Results: To control for the effects of large samples and to validate the results, the authors conducted all analyses for half (6282) the sample of hypertensive patients who met the study criteria (12,563). A total of 132 primary care physicians who met the study criteria were identified. The patients made on average 9.3 ambulatory visits to physicians (both general practitioners and specialists) in 1994/95. Those who had more complex medical conditions (i.e., were formally referred to a specialist), those who had 3 or more serious medical problems and those who had been admitted to hospital made more visits to their primary care physician than those without these characteristics. After these and other key patient characteristics were controlled for, a primary care physician's patient recall rate in 1993/94 was strongly related to the number of visits his or her hypertensive patients made to all doctors for any reason in 1994/95. Physicians with high patient recall rates (i.e., who saw their hypertensive patients on average 8 or more times) in 1993/94 also had high recall rates in 1994/95.Interpretation: Because patient characteristics most strongly associated with high visit rates were those reflecting patient illness, policy measures aimed at patients (e.g., user fees and deinsurance) do not appear to be the appropriate policy tool for dealing with high visit rates. Given the influence of a physician's patient recall rate on patient visit patterns, physician profiling and feedback may prove more appropriate. [ABSTRACT FROM AUTHOR]

Compares the health care system between Canada and the United States. Evidence on comparative system performance; Association between income distribution and health status on health care allocated by Canadians; Differences between Canadian and American systems in the access to care and outcomes for people with lower incomes.

Examines changes in the Canadian physician supply between 1986 and 1994 and assesses the availability of physicians in 1994 relative to population growth and aging. Methods; Results; Interpretation; Why the aging of Canada's population poses no threat of shortage to the Canadian physician supply.

Presents a study to show the use of needs-based planning in identifying resource misallocation in a provincial medical system faced with funding constraints for physician services. Design of the study; How all Manitoba residents are participating; Outcome measures; Results and conclusions. INSET: Estimating need for physician visits with the Socio-Economic...

Presents a study to describe characteristics associated with inappropriate hospital use in order to help target utilization reviews in Manitoba. Design of the study; Patients; Outcome measures; Results and conclusion.

Abstract: This paper uses claims data from a universal health care system to describe physicians' hospitalization styles after adjusting for case-mix characteristics of their primary patients. Patients were uniquely assigned to that physician (general or family practitioners, internist, general surgeon, or obstetrician/gynecologist) seen most frequently over each two two-year periods (1972-74 and 1974-76). Four indices were developed including: 1) percentage of primary patients hospitalized; 2) mean number of readmissions for such patients; 3) mean length of stay; and 4) total days of hospitalization per primary care patient (a summary measure combining the first three). Rates of admission, not length of stay, were shown to be strongly related to this summary measure. Marked variations in the hospitalization indices were observed across physicians; these variations cannot be explained by the health or sociodemographic characteristics of a physician's patients. Rural physicians practicing in areas with high bed-to-population ratios and low occupancy rates were particularly high users of hospitals. The economic implications of different practice styles are shown to be large; physicians who were high users of hospitals serve 27 per ¢ of the patients but their patients consume 42 per ¢ of the hospital days. [ABSTRACT FROM AUTHOR]

Abstract: The impact of centralized facilities on access to care was tested by studying total hip arthroplasty in the Province of Manitoba,. Canada. Data from the Manitoba Health Services Commission, which insures costs of all medical services in the Province, show that the availability of this surgical procedure has increased steadily over the 1973-78 period at a rate similar to that elsewhere in North America. Although Manitoba;s population is geographically dispersed specialized orthopedic services are concentrated in two urban centers. No important difference in access to care for this condition was found between urban center residents and residents distant from the surgical facilities. [ABSTRACT FROM AUTHOR]

This analysis focuses on the practice of hysterectomy across 33 hospital catchment areas of one Canadian province, using claims data from the Manitoba health insurance system. Hysterectomy rates varied five-fold across hospital areas. The availability of hospitals and physicians was unrelated to area rates, and there appeared to he no access barriers in the low-rate areas. High-rate areas were characterized by women who visited large numbers of different physicians and by having larger proportions of French, Polish. and Italian residents (ethnic groups which are largely Catholic in Manitoba). Although women residents of high rate areas made somewhat more visits for gynecologic problems and had many more D&Cs dilation and curettage of the uterus), it is concluded that this may be due as much to the practice style of physicians treating patients from these areas as to gynecologic need. Residents of high and medium-high rate areas are more likely to have hysterectomyprone surgeons as their primary physicians. Such physicians appear both more likely to "label" their patients' conditions as gynecologic in origin and more likely to advise surgical intervention (both D&C and hysterectomy] once such conditions are diagnosed. Thus, a combination of patient and physician characteristics may explain much of the variation in small area hysterectomy rates, rather than narrowly defined medical need. [ABSTRACT FROM AUTHOR]

This paper assesses the risks and benefits associated with hysterectomy by comparing the age-adjusted health care usage patterns of all women receiving hysterectomy in the Province of Manitoba in 1974 during the two years before and the two years after surgery with those of women undergoing cholecystectomy, and with those of an age and sex matched population sample. Less than half of the women have dilation and curretage of the uterus prior to hysterectomy, despite the fact that menstrual disorders are the most frequent problem bringing women to the physician's office. Despite a low mortality rate, there is a significant risk (40 per 1,000 cases) of complications requiring hospital readmission during the two years after hysterectomy and associated repair procedures. Although women visit their physician less frequently with gynecologic problems after surgery, they visit more frequently for psychological problems, urinary trace infections, and menopausal symptoms. Both before and after surgery women visit the physicians more frequently than do the age-matched comparison groups. [ABSTRACT FROM AUTHOR]

Patterns of surgical practice, the type of operations performed, and risk characteristics of elderly patients brought to surgery are examined in areas with differing surgical rates. This population-based analysis covering Manitoba's 56 rural hospital areas uses discharge claims filed routinely with the provincial Health Services Commission. One and a half times as much surgery was performed in high rate areas (115.2 procedures per 1,000 elderly) as in low rate areas (74.7 procedures/1,000). Since surgical case mix varied little between high and low rate areas, the rate variation means that place of residence strongly influences exposure to major surgical procedures. In similar fashion, the proportion of surgical cases classified as high-risk does not vary with the surgical rate. High risk patients resident in high surgical rate areas are more likely to come to surgery than are their counterparts in low rate areas. Further analyses of nonsurgical hospitalization, of three common elective procedures, and of area characteristics were carried out. The surgical selection process, not characteristics of the population residing in the area, appears to determine the rate at which high and tow risk patients come to surgery. Our research c]early suggests that high surgical rates carry with them the risk of excess surgical deaths. [ABSTRACT FROM AUTHOR]

Investigates how a universally insured health care system delivers care that are related to health status. Characteristics of residents in Winnipeg, Canada, by relative affluence of neighborhood; Differences in age and sex-standardized death rates across the population; Hospital use by relative affluence of neighborhood, using Winnipeg's type of hospitalization.

Presents information on the development of a population health information system (POPULIS) in regions of Manitoba, to help the United States public understand that more health care is not necessarily better and help planners identify the levers for combing the concerns of population health and cost containment. Steps for developing a population-based system to compare health status, various critical risk indicators and hospital use.

Objectives. Prenatal care is commonly understood to have a beneficial impact on birthweight. This study describes socioeconomic differences in utilization of prenatal medical care and birthweight in a population with universal health insurance. Methods. Measures of Prenatal care utilization, incidence of pregnancy complications, and birthweight were obtained from physician reimbursement claims and hospital separation abstracts for 12 646 pregnant women. Maternal socioeconomic status was derived from small-area census data. Results. Infants born to women in the poorest income quintile had lower birthweights than infants born to wealthier women. Much of the difference was associated with a higher prevalence of complications, smoking, unmarried status, and inadequate prenatal care among low-income women. The differnce in birthweight between adequate and less than adequate care groups was small, and the benefit associated with prenatal care was not greater among women with pregnancy complications. Conclusions. The lower utilization of prenatal care by poorer women accounted for a small proportion of the difference in birthweight. Socioeconomic differences in birthweight are primarily attributable to factors not directly influenced by early prenatal medical care. [ABSTRACT FROM AUTHOR]

In Manitoba, Canada, a representative cohort of elderly individuals ages 65 to 84 (n = 3,573) were interviewed in 1971 and the survivors of this cohort were reinterviewed in 1983. This analysis assesses the determinants of successful aging--whether or not an individual will live to an advanced age, continue to function well at home, and remain mentally alert. Over 100 separate indicators of demographic and socio-economic status, social supports, health and mental status in 1971 were available as potential predictors of successful aging. Indicators of access to health care over the period 1970-82 and indicators of diseases over this period were also available as predictors. Those who aged successfully were shown to have greater satisfaction with life in 1983 and to have made fewer demands on the health care system than those who aged less well. Despite the large number of potential predictors of successful aging which were examined, only age, four measures of health status, two measures of mental status, and not having one's spouse die or enter a nursing home were shown to be predictive of successful aging. [ABSTRACT FROM AUTHOR]

Compares the bureaucracies of Turkey, Egypt and Pakistan. Marginal importance of the religious similarity among the countries for the student of Middle Eastern bureaucracies; Attitudes of bureaucrats in the three countries; Indicators of job satisfaction in bureaucrats.

This article discusses the criticisms leveled by Evelyn Vingilis and Jacquelyn Burkell in "A Critique of an Evaluation of the Impact of Hospital Bed Closures on Winnipeg, Canada: Lessons to be Learned from Evaluation Research Methods." Vingilis and Burkell repeatedly mention the inadequacy of using only one year of "follow-up" in determining the impact of bed closures in Winnipeg. We couldn't agree more. It was never our intention to have the "First Report," as the name implies, to be the last word on hospital downsizing in Winnipeg. They wrongly suggest that this design is vulnerable to most of the threats to internal and external validity. They are, in fact, correct that the design is vulnerable to the threat of maturation, but interestingly, one of their suggestions for overcoming this threat would only introduce additional threats to internal validity. In a perfect world, health care researchers could monitor a system for years before reporting on the impact of change. In this less than perfect world, however, policy is made and beds are closed.

The article presents a research examining gestational age at birth and neonatal jaundice readmission. It mentions that gestational age was obtained from the maternal delivery record and based on menstrual dates or second-trimester ultrasound. It also mentions that gestational age was entered as an interaction with short stay in the regression model, but the interaction was not significant each was entered independently into the final model.

Presents a response by Noralou P. Roos and Evelyn Forget to letters to the editor about public health expenditure.

Discusses the difficulties in determining the right rate for various medical procedures. Context to key health policy issues; Reasons for fluctuation in rates across Canada; Argument for more research about the cost-effectiveness of investment in medical care; Preservation of the Canadian medicare system.

Refutes media headlines in British Columbia concerning the downsizing of hospitals. Allegations that the downsizing will increase death rate, decrease access to hospitals, and result in discharge of people who are still sick; Study by Samuel Sheps and colleagues which did not find evidence of negative effects from the downsizing.

Editorial. Presents the author's opinion on resource allocation of physicians in Canada. The mention of benchmarking, needs-based, and supply and demand planning; The logic of shifting physician resources away from surplus to deficit areas.

A letter to the editor is presented in response to article "Federal Committee to Review Pfizer V-P Appointment to CIHR council," by A. Silversides in the November 9, 2009 issue.

Objective: To examine 9-year rates of family physician (FP) and psychiatrist use, as well as patterns of mental health services delivery by FPs. Method: We used population-based data from Winnipeg, Manitoba, to construct mutually exclusive cohorts of adults treated for major or minor mental health disorders in fiscal years 1992-1993 to 2000-2001. For each year, we measured patterns of use in this population and patterns of mental health practice among FPs. Results: The treatment prevalence rate was 224 per 1000 in 2000-2001 and 174 per 1000 in 1992-1993, and the rates for major and minor mental health disorders increased over the 9-year period by 15% and 31%. respectively. In 2000-2001. 92% of adults treated for mental illness saw at least one FP, and 45% saw an FP but no psychiatrist. Adults with major or minor mental health disorders visited an FP on average 9.1 and 6.9 times yearly, respectively, and FP visit rates remained relatively stable. There was a gradient in use by socioeconomic status: adults from communities with lower socioeconomic status had the highest rates of use. By 2000-2001, 24% of FPs billed for services related to psychosocial conditions as often as they did for the most frequent conditions seen in primary care. Conclusion: Between 1992-1993 and 2000-2001, the study population's patterns of FP and psychiatrist use remained relatively stable. In more recent years, FPs provided more mental health services than in previous years; this related to increased treatment prevalence rather than to increases in use per adult. FPs played a major role in the provision of mental health care. [ABSTRACT FROM AUTHOR]

The current study examined school readiness for children placed in care of child protection services before age 5. This association was assessed using a population-based cohort of children born in Manitoba, Canada, between 2000 and 2009 (n = 53,477) and subcohorts of discordant siblings (one sibling taken into care, one sibling not taken into care; n = 809) and discordant cousins (n = 517). In the population analysis, children placed in care were significantly less likely to be ready for school; this difference was not seen in the discordant sibling or cousin analysis. The findings suggested that differences in school readiness for children placed in care are a result of broader social factors affecting families, not placement into care. [ABSTRACT FROM AUTHOR]

Social stratification and life course approaches are enlisted to study the effects of health and social events on early adult welfare use. Given the strong link between individual and parental economic disadvantage, the mechanisms by which social context affects welfare use are examined. This unique approach is made possible by the linkage of several administrative databases in Manitoba, Canada, allowing for the follow-up of a large population (n = 42,598) and subpopulation of siblings (n = 7920) from birth to age 26. Gradients of inequality were found for many of the predictors. Regardless of background, improved educational achievement and better childhood and adolescent mental health seem likely to decrease the use of welfare in early adulthood. Addressing the risk factors identified in this study would reduce inequities and lower the need for welfare in early adulthood. [ABSTRACT FROM AUTHOR]

A newborn screen designed to predict family risk was examined to: (a) determine whether all families with newborns were screened; (b) evaluate its predictive validity for identifying risk of out-of-home placement, as a proxy for maltreatment; (c) determine which items were most predictive of out-of-home placement. All infants born in Manitoba, Canada from 2000 to 2002 were followed until March 31, 2004 (N = 40,886) by linking four population-based data sets: (a) newborn screening data on biological, psychological, and social risks; (b) population registry data on demographics; (c) hospital discharge data on newborn birth records; (d) data on children entering out-of-home care. Of the study population, 18.4% were not screened and 3.0% were placed in out-of-home care at least once during the study period. Infants not screened were twice as likely to enter care compared to those screened (4.9% vs. 2.5%). Infants screening at risk were 15 times more likely to enter care than those screening “not at risk.” Sensitivity and specificity of the screen were 77.6% and 83.3%, respectively. Screening efforts to identify vulnerable families missed a substantial portion of families needing support. The screening tool demonstrated moderate predictive validity for identifying children at risk of entering care in the first years of life. [ABSTRACT FROM PUBLISHER]

Abstract: Information-rich environments in Canada, Australia, and the United Kingdom have been built using record linkage techniques with population-based health insurance systems and longitudinal administrative data. This paper discusses the issues in extending population-based administrative data from health to additional topics more generally connected with well being. The scope of work associated with a multi-faceted American survey, the Panel Study in Income Dynamics (PSID), is compared with that of the administrative data in Manitoba, Canada. Both the PSID and the Manitoba database go back over 30 years, include families, and have good information on residential location. The PSID has emphasized research design to maximize the opportunities associated with expensive primary data collection. Information-rich environments such as that in Manitoba depend on registries and record linkage to increase the range of variables available for analysis. Using new databases on education and income assistance to provide information on the whole Manitoba population has involved linking files while preserving privacy, scaling educational achievement, assessing exposure to a given neighborhood, and measuring family circumstances. Questions being studied concern the role of the socioeconomic gradient and infant health in child development, the comparative influence of family and neighborhood in later well being, and the long-term effects of poverty reduction. Issues of organization of research, gaps in the data, and productivity are discussed. [Copyright &y& Elsevier]

A letter to the editor is presented in response to an article about the screening of immigrants for tuberculosis and other communicable diseases.